[Gangrene of Fournier with urethral involvement: urethral reepitelization with conservative treatment].
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Fournier Gangrene↗
Biomedical subjects
S Arlandis Guzmán
Publications and source records attributed to S Arlandis Guzmán.
[Comparative study between tobramicin and tobramicin plus ciprofloxacin in transrectal prostate biopsy prophylaxis].
INTRODUCTION AND OBJECTIVES: To compare the efficacy of tobramicin and tobramicin + ciprofloxacin for prevention of transrectal prostatic biopsy infectious complications. We revised our complications, microorganism most common in the infectious complications, and their sensibility. MATERIAL AND METHODS: Prospective and randomized study in 153 patients with 157 prostatic biopsies. The 71 patients in group A were treated with intramuscular tobramicin 100 mg, one dose 30 minutes before biopsy and another one 8 hours afterwards. The 85 patients in group B were treated with the same tobramicin doses and oral ciprofloxacin 500 mg, one dose 30 minutes before biopsy and afterwards they continue with the ciprofloxacin every 12 hours during 3 days. RESULTS: we did 71 biopsies in group A and 86 in group B. 50 (31,8%) patients had hematuria, 20 (12,7%) fever, 15 (9,5%) hemospermia, 7 (4,4%) perineal pain, one (1,2%) orchiepididymitis and another one (1,2%) urinary retention. The patients who had fever were 15 of the group A and 5 of the group B (p=0,004). A total of 15 (21,1%) patients with fever of the group A needed to be treated in the hospital and 3 patients (3,5%) of the group B (p=0,0006). E. coli growthed in 67% of the blood cultures and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins were the antibiotics more eficacious. CONCLUSIONS: Prophylaxis scheme with tobramicin plus ciprofloxacin was more efficacy that tobramicina alone in transrectal prostatic biopsy. Hematuria was the most common complication. E. coli was the microorganism most frequent in infectious complications after prostatic biopsy and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins the most effective antibiotics in our hospital.
Aged↗
[Foreign bodies in the urethra and bladder: our experience].
We report the urethra and bladder foreign bodies seen in our department from 1976 to September 2004. We review the kind of the foreign bodies, the psychological profile of the patient, the clinical findings, diagnosis and treatment. We also review the literature about this matter.
Adolescent↗
[Secondary vesical amyloidosis].
The bladder involvement is a very unusual fact in systemic amyloidosis. The distinction of primary and systemic amyloidosis disease with bladder involvement (secondary bladder amyloidosis) is important to the urologist. Secondary amyloidosis of the bladder is a rare disease entity (approximately 20 cases published). We document a case of a woman with a large history of rheumatoid arthritis who developed severe macrohematuria. Diagnosis was done by biopsy that revealed amyloidosis, and it was confirmed with an immunohistochemical staining of the specimens that defined the process as amyloid AA (secondary amyloidosis).
Aged↗
[Melanosis of the bladder: a very uncommon entity].
Melanosis of the bladder is a rare entity characterized by anomalous deposits of melanin-containing pigment on the vesical urothelium without melanocytic atypia or associated malignant melanoma. To our knowledge and following such strict criteria, there are only five cases previously reported. The biological potential of this entity is uncertain because of the rarity of their. We report one case of simple melanosis of the bladder confirmed by histological examination and inmunohistochemistry analysis. We believe that recognition of this entity is important.
Aged↗
[Vesicouterine fistula. Our experience of 25 years].
OBJECTIVE: To determine the current state of vesicouterine fistulae in our hospital, the factors associated with their development and the findings obtained from the treatments used. MATERIAL AND METHODS: We carry out a retrospective study on a group of patients suffering from vesicouterine fistulae who were treated in our service for the last 25 years with a 2 year minimum follow-up. RESULTS: 6 cases of vesicouterine fistulae were evaluated. In 83.3% (5/6) of the cases occurred following caesarean section. The average age of the patients was 36.5 years old. In 50% of the cases, urinary incontinence immediately after surgery determined an early diagnosis. In 5 patients deferred abdominal surgical approach was carried out. All of the patients remained asymptomatic during the follow-up years. Two pregnancies were recorded 24 months after repair with a full term delivery. CONCLUSIONS: The vesicouterine fistula, despite being infrequent, is no longer an exceptional diagnosis. Currently, the low segmentarian caesareans constitute the major isolated risk factor for fistula development. We recommend a deferred surgical repair without discarding a conservative approach for those cases of small and early fistula.
Adult↗
[Primary retroperitoneal tumors: our caseload].
Primary retroperitoneal tumors are a very uncommon group of neoplasias in urology. Sixty-four primary retroperitoneal tumors admitted and treated in our hospital from january 1974 to october 2000 were reviewed retrospectively. Clinical presentation, diagnostic, treatment and evolution are analyzed. Five cases were benign (7.8%) and the remains malign (92.2%). Mesodermic tumors were the most frequent. Surgery was performed in 59 patients (92.2%). Radical resection was possible in 100% of benign tumors and 44.5% of malignant tumors. Palliative radiotherapy was performed as the only treatment in 3 patients. Two patients received only symptomatic treatment. Adjuvant chemotherapy (32 patients, 50%) and radiotherapy (19 patients, 29.6%) completed the treatment. Benign tumors 5-year global survival was 100%, malignant tumors 1-year survival was 47.4%, 3-year survival 15.2% and 5-year survival 10.1%. Mean survival was 20.15 months. As it's frequent to find an advanced neoplasm at the diagnostic, surgery must be planned with radical intention. Radiotherapy and chemotherapy could be useful in the therapeutic strategy of these tumors with poor prognosis.
Adolescent↗
[Renal and perirenal abscess].
Renal and perirenal abscesses are rare infections of the urinary tract traditionally caused by Staphylococcus aureus. Today however there is a predominance of abscesses secondary to coliform bacteria such as E. coli. This paper presents a revision of our series over the last ten years (1987-1996). A total of 11 abscesses (3 renal and 8 perinephritic) were recorded. The most frequent symptom for visiting the clinic was back pain. All patients had predisposing associated conditions. The microbiological analysis revealed E. coli in most abscesses. An HIV+ patient had bilateral renal abscess secondary to Aspergillus fumigatus. CAT appears to be the most specific method for imaging diagnosis, and ultranosography is useful not only to guide percutaneous puncture but also in the follow-up of abscesses after antibiotic treatment. Two renal abscesses resolved with parenteral antibiotic therapy and subsequent observation. Three cases required ultrasound guided percutaneous puncture and intravenous antibiotic therapy. Surgical drainage was required in four. A revision of our experience and the recent literature verified the changes that have taken place in the last few years both in the etiopathogenesis as well as the diagnostic and therapeutical methodology of renal and perinephritic abscesses.
Abscess↗
[Cost-effectiveness of different diagnostic tests for the study of benign prostatic hyperplasia].
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Cost-Benefit Analysis↗
[Urinary and sexual alterations in multiple sclerosis].
Urinary and sexual symptoms in patients with multiple sclerosis (MS) are frequent, although this question has scarcely been addressed in our country. The aim of this study is to prospectively evaluate the presence of such symptoms in 77 MS patients. We have valued the neurological involvement and the degree of functional disability through the Minimum Dossier of Disability for Multiple Sclerosis. The urinary and sexual symptoms were collected through a directed survey. We have performed an urodynamic study in order to evaluate the bladder function. Urinary symptoms wire observed in 81.8% of patients, with predominance of the mixed syndrome (52%). Males show greater neurological affectation and functional disability, as well as greater urinary symptoms frequency (91%). The most frequent symptoms have been urgency (66.6%), frequency (60.3%) and dysuria (53.8%). The complications have been scarce, of infectious type (14.28%) and with female predominance. The most frequent urodynamic finding has been the detrusor hyperreflexia (60%). The minimum dossier of Disability for Multiple Sclerosis is useful to establish comparative parameters with other studies and with more specific urologic data. The presence of urinary symptoms in multiple sclerosis correlated with the degree of neurological (pyramidal and cerebellar) involvement and of functional disability in the Dysfunction Status Escale.
Adult↗
[Ruptures of double-J ureteral catheter. Our experience and review of the literature].
Ureteral double-J stents are currently being used widely in numerous urologic indications. Side effects are infrequent and usually related to the act of insertion per se. Complications with long-term indwelling stents are mainly due to stent incrustation and more rarely to spontaneous breakage. We report 3 cases of stent multiple fragmentation after and indwelling period superior to 22 months without evidence of stent incrustation. We reviewed the literature and analyzed the different etiologic factors that are thought to be involved. We believe that radiologic control post-insertion and stent substitution after an indwelling period of three months are mandatory.
Aged↗
[Renal traumatism: diagnostic protocol and therapeutic indications].
Review of 158 cases of renal traumatism attended ar the Urology Service of "La Fe" Hospital from 1984 to 1995. We analyze the indications of radiological study of the polytraumatized patient, the different classifications of renal traumatism and the changes produced in the diagnosis protocol, after substituting urography and arteriography for ultrasonography and CT in the Urgencies Area. We explain the treatment, complications and evolution of the patients in our series. 153 of the cases are closed traumatism and 5 of them are penetrating. Following the Chatelain's classification, 78.5% of the reviewed cases can be describes as traumatism grades I and II and in all the instances a conservative treatment was followed. Grades III and Iv (18.3%) were mostly treated surgically (82.7%) with 20.8% of complications that were solved conservatively except for one case, which required surgery. Every penetrating traumatism was dealt surgically and we practised nephrectomy in one of them (20%). We finally suggest, as the best moment for the reconstructive surgery, the period between the 3rd and the 10th day after the traumatism, due to the high rate of nephrectomy on the previous days and the technical difficulties which the haematoma fibrosis conveys on the subsequent.
Adolescent↗
[Peripheral nerve evaluation:indications, technique and results].
INTRODUCTION: Sacral nerve neuromodulation is a new treatment modality for patients with chronic voiding dysfunction (CVD). The aim of this treatment is to restore the disbalanced micturition reflexes by electrical stimulation ot the sacral roots. Peripheral Nerve Evaluation (PNE) is the first step needed to determine wether sacral nerve stimulation for the control of lower urinary tract dysfunction is appropriate for a given patient, yielding accurate information about the location, integrity and function of sacral nerves, and motor and sensorial responses to electrical stimulation. PATIENTS AND METHOD: 43 PNE in 28 patients (13 man and 15 women) were performed between january 2000 and november 2001 (mean age 56.3 years old, 22-76). Every patient have been diagnosed of CVD: 13 Urinary Urge Incontinence (UUI). 5 Urgency-Frequency Syndrome (UFS), 7 Dysfunctional Voiding (DV) and 3 Mixed Syndromes (1 patient UFS + DV and two patients with UUI + DV). RESULTS: Every acute stimulation showed positive sensory and motor responses. There was premature lead migration in 8 PNE (18.6%), preventing an appropriate evaluation of the temporal stimulation. 35 PNE were evaluated after a 6.5 days period (3-15) of electrical stimulation. There were no significative complications, and PNE was well tolerated. Good clinical results (> 50% reduction in symptoms) were observed in 7/13 patients with UUI (53.8%), 2/5 patients with UFS (40%), 1/7 patients with DV (14.2%) and 1/3 patients with mixed syndromes (UUI + DV) (33.3%). 11 of 28 patients with CVD (39.2%) have been selected as candidates for permanent implantation. CONCLUSION: Actually, PNE is the first step needed to determine wether sacral nerve stimulation for the control of lower urinary tract dysfunction is appropriate for a given patient. With PNE we can select properly adequate candidates for permanent implantation. It is an easy and well tolerated technique, and can be performed in any medical center in an outpatient basis.
Adult↗
[Neurologic changes in patients with multiple sclerosis].
OBJECTIVE: To evaluate the presence of urinary symptoms in 77 patients with multiple sclerosis. METHODS: The neurological compromise and the degree of functional disability were evaluated through the Minimum Dossier of Disability for Multiple Sclerosis. The pertinent data for the urinary symptoms were collected through a directed survey. A urodynamic study was performed to evaluate bladder function. RESULTS: 81.8% of the patients had urinary symptoms, the most prevalent being the mixed syndrome (52%). Neurological involvement and functional disability were greater in the male patients and there was a higher incidence of urinary symptoms (91%). Urgency (66.6%), frequency (60.3%) and dysuria (53.8%) were the most common urinary symptoms. The complication rate was low; infection was the most common complication (14.28%) and was more prevalent in the females. Detrusor hyperreflexia (60%) was the most frequent urodynamic finding. CONCLUSIONS: Urinary symptoms are frequent in multiple sclerosis (81.8%), the most prevalent being the mixed syndrome. Neurological involvement and functional disability are greater in the male patients and there is a higher incidence of urinary symptoms. There is a significant correlation between the severity of neurological compromise (pyramidal and cerebellar) and the degree of functional disability and the presence of urinary symptoms.
Adult↗